针药并用治疗类风湿关节炎疗效观察(英文)

目的:观察针药并用治疗类风湿关节炎的临床疗效。方法:将80例类凤湿关节炎患者随机分为2组,观察组40例予抗风湿药及针刺治疗;对照组40例予与观察组相同的抗风湿药治疗。治疗3个疗程后观察疗效。结果:治疗后,观察组患者晨僵时间、双手平均握力、关节压痛指数、关节肿胀指数均显著改善,与本组治疗前有统计学差异(P<0.01);关节压痛及双手平均握力改善程度优于对照组(P<0.05)。对照组各症状指标较治疗前亦有显著改善(P<0.01,P<0.05)。治疗后,两组健康评估问卷(HealthAssessmentQuestionnaire,HAQ)评分均有明显改善(P<0.01,P<0.05),红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、C反应蛋白(C-reactive Protein,CRP)均有明显下降(P<0.01,P<0.05),观察组CRP下降程度优于对照组(P<0.05)。结论:针刺疗法配合抗风湿药治疗能有效改善类风湿关节炎患者的日常生活能力(Activities of Daily Living,ADL),提高其生活质量。     

Medication adherence in patients with chronic non-malignant pain: Is there a problem?

Health care providers, treating patients with chronic non‐malignant pain, often experience that medication is not as effective as expected. It is important to realize that the effectiveness of a pharmacological treatment can be influenced by the way the medication is taken. Medication adherence is a topic that gains more attention, especially in chronic conditions, because it affects treatment outcome. A systematic review of studies on medication adherence in patients with chronic non‐malignant pain was performed to gain insight in the prevalence of the problem, the impact on treatment outcome, influencing variables and interventions. Searching several electronic databases (Medline, CINAHL, Psychinfo and Cochrane), 14 relevant articles were found. The results indicate that medication non‐adherence is common in patients with chronic non‐malignant pain. Both overuse and underuse of medication occurs. However, due to the scarce literature and important methodological limitations, it is not possible to make firm conclusions concerning the impact on outcome, influencing variables and optimal intervention strategies. This review highlights some important gaps in the adherence literature in a chronic non‐malignant pain population and sets the stage for future research.     

寻甸县新型农村合作医疗制度补偿方案研究

目的：探讨寻甸县新型农村合作医疗制度补偿方案的科学性与可行性,指导实践。提高农民受益程度。以资在云南省范围内全面实施新农合制度时参考。方法：采用现场流行病学研究方法进行研究。结果：寻甸县新农合制度补偿方案是“家庭账户＋住院费用按比例补偿”模式。2004年度。在家庭账户方案保持不变的基础上对住院补偿办法做了较大幅度调整。两个乡（镇）参合农民对新农合制度补偿方案满意度评价分布的差异有统计学意义（P=0．001）,参合农民与医务人员对建立家庭账户方案评价分布的差异也有统计学意义（P=0．016）。结论;寻甸县现行新农合制度补偿方案基本可行。社会满意度较高。值得借鉴和推广,建议在不断调整和完善的基础上继续深入实施。     

An Improved Gas-Kinetic Scheme for Multimaterial Flows

The efficiency of recently developed gas-kinetic scheme for multimaterial flows is increased through the adoption of a new iteration method in the kinetic non-mixing Riemann solver and an interface sharpening reconstruction method at a cell interface. The iteration method is used to determine the velocity of fluid interface, based on the force balance between both sides due to the incidence and bounce back of particles at the interface. An improved Aitken method is proposed with a simple hybrid of the modified Aitken method (Aitken-Chen) and the Steffensen method. Numerical tests validate its efficiency with significantly less calls to the function not only for the average number but also for the maximum. The new reconstruction is based on the tangent of hyperbola for interface capturing (THINC) but applied only to the volume fraction, which is very simple to be implemented under the stratified framework and capable of resolving fluid interface in mixture. Furthermore, the directional splitting is adopted rather than the previous quasi-one-dimensional method. Typical numerical tests, including several water-gas shock tube flows, and the shock-water cylinder interaction flow show that the improved gas-kinetic scheme can capture fluid interfaces much sharper, while preserving the advantages of the original one.     

High-Order Gas-Kinetic Scheme in Curvilinear Coordinates for the Euler and Navier-Stokes Solutions

The high-order gas-kinetic scheme (HGKS) has achieved success in simulating compressible flows with Cartesian meshes. To study the flow problems in general geometries, such as the flow over a wing-body, the development of HGKS in general curvilinear coordinates becomes necessary. In this paper, a two-stage fourth-order gas-kinetic scheme is developed for the Euler and Navier-Stokes solutions in the curvilinear coordinates from one-dimensional to three-dimensional computations. Based on the coordinate transformation, the kinetic equation is transformed first to the computational space, and the flux function in the gas-kinetic scheme is obtained there and is transformed back to the physical domain for the update of flow variables inside each control volume. To achieve the expected order of accuracy, the dimension-by-dimension reconstruction based on the WENO scheme is adopted in the computational domain, where the reconstructed variables are the cell averaged Jacobian and the Jacobian-weighted conservative variables. In the two-stage fourth-order gas-kinetic scheme, the point values as well as the spatial derivatives of conservative variables at Gaussian quadrature points have to be used in the evaluation of the time dependent flux function. The point-wise conservative variables are obtained by ratio of the above reconstructed data, and the spatial derivatives are reconstructed through orthogonalization in physical space and chain rule. A variety of numerical examples from the accuracy tests to the solutions with strong discontinuities are presented to validate the accuracy and robustness of the current scheme for both inviscid and viscous flows. The precise satisfaction of the geometrical conservation law in non-orthogonal mesh is also demonstrated through the numerical example.     

用提升格式CDF9/7小波变换和零树编码算法对X线医学图像压缩性能的研究

目的研究提升格式的CDF9/7小波变换和零树编码对X线医学图像的压缩性能.方法分别用基于提升格式CDF9/7小波变换的压缩方法和JPEG标准对X线医学图像进行压缩,包括乳腺钼靶图像、计算机摄影图像和计算机断层图像,压缩比从 3:1到40:1.用主观和客观方法评价压缩图像质量.结果与JPEG标准相比,本文的方法能够获得更好的图像质量和更高的压缩比;与基于Mallat算法的常规CDF9/7小波变换编码相比,提升格式的CDF9/7小波变换和零树编码可减少图像压缩的计算时间.结论本文提出的基于提升格式的CDF9/7小波变换和零树编码的医学图像压缩方法,可满足X线医学图像存储和传输的要求,并符合DICOM 3.0支持的最新的JPEG 2000图像压缩标准.     

Perspectives From Academic and Practice Leaders on Nursing Student's Education and Role in Medication Reconciliation

Background

Medication reconciliation is a complex process that occurs during hospitalization at admission, transfer and discharge and at each outpatient clinic visit. Despite numerous quality improvement initiatives implemented by healthcare facilities nationwide to refine the process, medication errors still occur. Medication reconciliation processes are institution specific and undergo constant refinement. Few reports are available on the nursing student's role in this contemporary safety process.

Conciliation médicamenteuse d’entrée en service de médecine interne : retour d’expérience après un an de pratique

Since April 2015, medication reconciliation is performed in our Department. The objective of this study is to assess the impact of this activity on patients’ care after one year of practice.

Agreement between patient report and medical record review for medications used for rheumatoid arthritis: The accuracy of self‐reported medication information in patient registries

Objective

With the growth in patient registries in rheumatic disease research, it is important to validate the collected information. We examined the convergent validity of self‐reported medication use for rheumatoid arthritis (RA).

Methods

In the setting of the Brigham Rheumatoid Arthritis Sequential Study (BRASS), a large registry of patients with RA, we examined the agreement between patients' self‐report of current and past RA medication use and information from medical records. For a sample of patients in BRASS, these 2 sources of information were compared using the kappa statistic as well as the percent agreement.

Results

The 91 patients selected for assessment were typical of a prevalent RA cohort: >80% were women and the mean disease duration was 16 years. The agreement for current medication use was excellent, ranging from 0.71 for sulfasalazine to 0.96 for methotrexate. However, for past medication use agreement was lower, ranging from 0.13 for methotrexate to 0.74 for aurothioglucose. The weighted kappa for cumulative oral glucocorticoid dose was 0.67.

Conclusion

Self‐report of current medication use and cumulative oral glucocorticoid dose appears to have moderate to excellent validity. However, self‐report of past medication use may not be valid.